NR 601 Week 6 iHuman Virtual Patient Encounter- Neurological System (Graded)

Paper Instructions

The following table summarizes your performance on each section of the case, whether you completed that section or not.

• Time spent: 6 hrs 39mins 27sec
• Status: Submitted

Case Section	Status	Your Score	Time spent	Performance Details
History	Done	100%	23min 43sec	57 questions asked, 41 correct, 0 missed relative to the case’s list
Physical exams	Done	96%	18min 29sec	39 exams performed, 25 correct, 0 partially correct, 0 missed relative to the case’s list
Key findings organization	Done		4min 33sec	13 findings listed; 16 listed by the case
Problem statement	Done		2min 0sec	96 words long; the case’s was 64 words
Differentials	Done	100%	2min 57sec	9 items in the DDx, 9 correct, 0 missed relative to the case’s list
Differentials ranking	Done	100% (lead/alt score) 100% (must not miss score)	0sec
Tests	Done	100%	3min 23sec	11 tests ordered, 11 correct, 0 missed relative to the case’s list
Diagnosis	Done	100%	58sec
Management plan	Done		11sec	796 words long; the case’s was 311 words
Exercises	Done	100% (of scored items only)	1min 51sec	10 of 10 correct (of scored items only)

 

Attempt History Questions ( 41 correct)

1. What is your name (patient)
2. Where are you?( patient)
3. What time is it? patient))
4. What happened?( patient)
5. How can I help you today (patient)
6. Do you feel confused at times? (patient)
7. Have you dropped many of your activities and interests? (patient)
8. Do you have trouble with reasoning, planning or organizing? (patient)
9. Have you noticed a decline in your thinking? (patient)
10. Have you been depressed? (patient)
11. Do you have a problem remembering things. (patient)
12. How would you describe your mood? (patient)
13. Do you sometimes have trouble remembering things or finding the right names or words? (patient)
14. How can I help her today?(witness)
15. Does she have any other symptoms or concerns we should discuss? (patient)
16. Has she lost weight (witness)
17. Does she have a problem with depression (witness)
18. Has she lost interest in things that used to give her pleasure? If so how often does she feel this way (witness)
19. Does she have trouble with reasoning, planning or organizing (witness)
20. Has she noticed a decline in her thinking (witness)?
21. Has she recently had any mood or personality changes? (witness)
22. When did her confusion start (witness)?
23. Does her confusion come and go? (witness)
24. Is there any pattern to when her confusion occurs? (patient)
25. Can she describe the nature of confusion or the types of memory loss (witness)
26. What treatments has she had for her confusion? (witness)

The medical problem list you have compiled should be a list that includes everything that is out of the ordinary about this patient, even when it is not a “problem” in the true sense of the word. In this 79-year-old female, the most significant active problem (MSAP) is impaired memory and related behavioral changes. Look through the list of problems identified. What medical conditions frequently found in the geriatric population has this list:

• Personality change
• Confusion
• Poor concentration
• Impaired judgment
• Paranoid ideation
• Disengagement/loss of interest in valued activities
• Decline in performance of ADLS .
• Unintended weight loss

Some problems could be grouped as potential risk factors for behavioral changes:

• Hypertension
• Hyperlipidemia
• History of head trauma
• Newly widowed status (despite low but somewhat ambiguous geriatric depression score)

Next look for specific physical findings identified during your examination of the patient. Hearing loss is a common, non-specific finding but the loss of orientation to time is significant. In whatmedical conditions is this a prominent finding?

In developing your differential diagnosis, keep in mind that there not only may be cross-over findings between various hypotheses, but that some conditions that may explain Ms. Riley’s presentation may actually coexist as mixed etiologies, or as comorbidities. Also remember that the geriatric population frequently does not exhibit the same degree of physical findings for some medical conditions, thus more generic screening for common conditions that can result in the above list of problems needs to be considered.